Bulimia Nervosa

Bulimia is an eating disorder characterised by repeated episodes of overeating and a persistent preoccupation with weight control. A number of studies suggest that up to 1 per cent of the population suffers from bulimia nervosa at any one time. Other studies suggest that up to 7 per cent of young women consulting their GP have symptoms that indicate the presence bulimia nervosa.

What are the symptoms?

According to the World Health Organisation (WHO), the disgnostic criteria for bulimia nervosa include:

persistent preoccupation with eating and an irresistible craving for food.

episodes of overeating in which large amounts of food are consumed in short periods of time.

excessive exercise, induced vomiting after eating, starving for periods of time or taking medicines such as laxatives or diuretics to counteract the bingeing.

fear of obesity, which is also seen in people with anorexia nervosa, and there is some overlap in the symptoms of these two diseases.

What is the cause of the bulimia nervosa?

The cause of bulimia nervosa is essentially unknown. In some cases an early trauma will be present, in other cases trauma is absent and the behaviour is copied by observing others.

Factors in the patient's home and social environment are thought to be important, these include cultural pressures for women in the West to maintain an unnaturally slender body weight. Despite this, most people with bulimia nervosa tend to maintain a normal body weight. Patients with bulimia nervosa often have low self-esteem and a negative self-image.

What are the symptoms of bulimia nervosa?

People with bulimia nervosa often feel too fat and generally dissatisfied with how they look. They may choose to eat less and avoid foods that are known to be fattening. Bulimia nervosa patients become preoccupied with eating and food. They will have rolling episodes of craving foods followed by bingeing, often in secret. After bingeing, they feel guilt, and may make themselves vomit or take other extreme weight control measures such as using laxatives or exercising excessively.

What can bulimics do to help themselves?

People with bulimia should first accept that they are suffering from bulimia nervosa and seek treatment. There are many good self-help books and websites available.

What is the course of the disease?

For some people bulimia nervosa is short-lived, more usually the bulimic symptoms will have been present for a considerable period of time before seeking help. The disease can persist for many years and can become a habitual part of life.

Bingeing and vomiting can however generate physical problems including erosion of teeth from stomach acid, and heart complaints due to the body being depleted of salts.

Diagnostic and statistical manual criteria (DSM)

Is Major Depressive Disorder or Dysthymia More Strongly Associated with Bulimia Nervosa?" Perez, Joiner & Lewinshon, Florida State University and Oregon Research Institute

Excerpts from the International Journal of Eating Disorders, July 2004 vol. 36 no. 1

"Analyses revealed that dysthymia was a stronger correlate with bulimia than major depression [in 937 adolescents], even while controlling for other mood disorders and a history of depression and dysthymia.

"The presence of dysthymia in adolescence might be possible risk factor for the development of bulimia nervosa."